Public Services

This report summarizes accomplishments and activities for the entire Public Services division of the Library. While, by necessity, endeavors of individual departments within Public Services are incorporated here, readers are encouraged to review the separate reports of those departments for more detail. This academic year saw a number of initiatives in working closely with students, assessment of various operations, and outreach/collaborative efforts across unit lines. Along the way, we achieved a number of accomplishments, witnessed a number of transitions, and faced some challenges. Student Engagement The Library continued to work throughout the year with the Student Advisory Group. In addition to providing feedback on a number of initiatives such as the one book project, the group also assisted with review of the proposed Library renovation programming and the programmatic/physical transition planning with the Clough Undergraduate Learning Commons (CULC). As a result of extensive planning in the previous academic year, Freakonomics had been selected as the title for the 2007-2008 one book project. The Library hosted several project sessions including one led by Bob Fox. The project was expanded in scope this year to provide for participation by all students rather than just freshmen. While project events were well-received, the project itself was somewhat hampered by turnover in its student


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remains in their hands, and is only loosely linked up with the public health local authority; but the tendency is for the whole of it to be undertaken by the local authorities. A large number of women medical officers hiavo been appointed to these posts during recent years. VENEREAL DISEASES. Schemes for the diagnosis and treatment of venereal diseasesare provided and administered by county councils and county borough council3. In some cases the officer is on the staff of the medical offioer of health, and in others he is an independent official. Special knowledge and practical experienoe in the treatment of venereal diseases are essential. The officer appointed for either whole-time or part-time services works at one or more clinics, and also gives instruction and assistanoe in the treatment of venereal diseases to general practitioners, who are allowed to attend tho clinics.
RE11UNEATION FOR SERVICzs. If we are to have skilled and highly trained medical officials of public authorities it is of course essential that they should receive salaries commensurate with their attainmenits and bearing a reasonable relation to the amount of time and money that have been expended in fitting them for their important and responsible duties. At present, no standard scale of remuneration for whole-time services has been adopted by public health authorities, although the British Medical Association and the Society of Medical Officers of Health-and more recently the Ministry of Health-have endeavoured to bring this about.
The present-day rate of remuneration for the whole-time services of a medical officer of health may be said to vary from £600 to £2,000 per annum, according to the dimzensions of the population served and the officer's experience; whileothe maximum salaries of the principal officers of the allied medical services are somewhat lower. The whole-time medical officer working under a senior medical officer in most cases receives a commencing salary of £600 per annum, with bonus in some cases.
There are good prospects of the adoption in the near futuro of a recognized scale of remuneration,which will provide a minimum commencing salary of £800 for a chief medical officer of health, of £750 for a chief medical officer of the allied medical services, and of £600 for all medical officers working under senior medical officerswhen the officers are not resident in an institution provided by the local public health authority and when they give their whole-time services.
THE REGULATIONS FOR THE DIPLOMA IN PUBLIc HEALTH.
The Examination. By the Regulations or Rules of the General Medical Council, which came into force on January 1st, 1924, the examination for the D.P.H. is divided into two parts, and no candidate is allowed to sit for the final part of the examination until two years have elapsed since a registrable qualification was obtained. The object of this two years' interval is " to provide opportunity for candidates for the Diploma or Degree in Sanitary Science, Public Health, or Stato Medicine, to pass from the state of pupilage to that of responsible3 practitioners, to give mature consideration to the obligations and duties involved in the work of the Public Health Service, and to acquire direct experience of medical work in a responsible capacity either in practico or in hospital or laboratory appointmenits.1 TLhe examination is both written and oral, aind must include pra-ctical examination in infectious diseases, food ins'ectiol', inspection of premises, dwellings, factories, workshops, schools, etc. Any candidate fromn the Dominions who possesses qualifications registrable in this country is eligible as a candidate for the examination, given that he has received such a course of training as that defined by the Regulations, at an institution which is approved by the General Medical Council.
The Curriculums for the Diploma in Public Hlealth. The curriculum must exrtend over a period of twelve months; and a candidate is admitted to either part of the examination after he has completed the prescribed courses of instruction in the subjects thereof. At least five months must be given to practical laboratory instruction in an institution approved by the licensing body, in the subjects: (1) Bacteriology and parasitology, including entomology, especially in relation to diseases of man and to those diseases transmissible to man from the lower animals (180 hours of such instruction is required).
(2) Chemistry and physics in relation to public health (90 hours of. such instruction is required).
(3) Meteorology and climatology (10 hours of such instruction is required).
Therefore at least 280 hours of practical instruction, extending over a period of at least five months, is demanded before a candidate is eligible for Part I of the examination.
For a candidate to become eligible for Part II of the examination he must first receive instruction in: (1) Principles of public health and sanitation (for approximately 30 hours).
(3) Sanitary-law and administration, mcluding public medical services (approximately 20 hours). 4) Sanitary construction and planning (approximately 10 hours). 5) Every candidate must also have made thirty attendances, of no less than two hours in each week of a three-months period, at the clinical practice of a recognized hospital for infectious diseasesand he must have received instruction in methods of administration.
(6) Every candidate must produce evidence that he has, during a period of not less than six months, been engaged in acquiring a practical kcnowledge of the duties, routine and special, of public health administration under the supervision of a medical officer of health, who shall certify that the candidate has received, from this officer or other competent medical officer, during not less than three hours on each of sixty working days, practical instruction in these duties, and those relating to: a) Maternity and child welfare service; b) Health service for children of school age; c Venereal diseases service; (t) Tuberculosis service, e) Industrial hygiene; Inspection and control of food, including meat and milk.
Certificates of having received the prescribed instruction in public health administration must be given by a medical officer of health who devotes his whole time to public health work; or by the medical officer of health of a sanitary area having a population of not less than 50,000; or in Ireland by the medical superintendent officer of health of a county or county borough having a population of not less than 50,OC0. THun Medical Departments of the Royal Navy, of the Army, and the Indian Government normally employed between them before the war some 3,000 medical men, and vacancies in tho ranks of these services were filled by offering commissions for competition once or more each year. In the abnormal circumstances arising out of the war and the period immediately following it the usual regulations for recruiting the permanent medical staff-of these services were, for the most part, in abeyance. has agreed for the meantime to waive its objections. The uncertainties of the position with regard to the Indian Medical Service are also explained below. A full statement of the mode of admission and conditions of service in the Royal Air Force Medical Service is given.
ROYAL NAVAL MEDICAL SERVICE. IN January, 1920, new regulations for retirement of officers came into force in the Royal Navy, and new rates of pay were e laid down. The new regulations inflicted a great injustice upon a considerable number of surgeon commanders who wer e nearing, or had passed, the new retiring age. The grievances arose under two heads-age of retirement and rate of pension-and frequent remonstrances were addressed to the Admiralty by the British Medical Association. Very briefly stated, these medical officers, who had entered the service on the understanding that they would be allowed to serve until the age of 55, were compulsorily retired at 50, and tieir maximum pension was fixed at £600 a year, representing an increase of but 10 per cent. on the former retired pay of their rank; it should be particularly observed that officers of other branches got increases of pension varying from 26 to 100 per cenit. In reply to representations by the British Medical Association the Admir alty admitted the grievance, and eventually made certaini proposals whiichl, after full consideration, the British Medical Association aas accepted.
Examinations for direct enitry into the Medical Service are at present in abeyance. Entries are made by means of the short-service scheme, and the regulations provide for the transfer to the permranent service of desirable shortservice officers. A short-service surgeon lieutenant, after six months' service, may be considered for transfer to the permanent service, and would be permitted to count his seniority from the date of entry for short service for pur poses of promotion, increment of full pay, and for retireed pay. Genral Conditions.
A candidate must be registered, must be under 30 years of age, and must be recommended by the dean of his school. UTnmarried candidates will be preferred. A candidate will beinterviewed by the Medical Director-General, R.N., and will undergo a physical examination. If considered eligible by the Medical Director-General his name will be submitted to the Board of Admiralt7 and he may be appointed " surgeon lieutenant for short service.' A candidate must engage for three years with the option of con.
tinuing for a further period of twelve months if his services are still required. The rate of pay is 25s. a day, or£4565s. a year, with the same allowances as are payable to permanentofficers of their rank. Lodging money at the rate of280 a year is usually allowed when employed on shore, without quarters in the United Kingdom, and£56 10s. a year in lieu of rations when not victualled in kind. In cases of temporary employment on shore not exceeding thir ty days, the lodging and provision allowances will be at the rate of 8s. and 3s. 6d. a day respectively. On joining an allow-anceof£50 for uniform will be made. When the new rates of pay were fixed it was decided that 20 per cent. should be considered as due to the then high cost of living. The rates set out above represant a reduction of approximately 5i per cent. owing to the decrease in the cost of living. The whole 20 per cent. is to be regarded as variable and subject to change on Julv 1st, 1927, and triennially thereafter either upwards or downwaras according as the cost of living rises or falls. An officer engaged for three years is entitled to receive two montlhs' notice of his services being no longer required. A gratuity of £8 6s. 8d. will be payable to officers for each completed month of service on completion of their period of service, or who are invalided for causes not within their own control before the completion of the prescribed period. Surgeon lieutenants R.N. for short service intending to apply for transfer to the permanent list must have been under 28 years of age at the time of their entry into the Royal Naval Medical Service. THE British Medical Associationhas for some time past bee-a in communication with the War Office withi regard to its failure to carry out undertakings it lhad given as to conditions of service and the amount of pension or gratuity pay.able on retirement. The Association is anxious that the War Office should be able to recruit stuitable medical men for the Royal Army Medical Corps, and the Naval and Military Committee had an interview with the Sere,tary of State for War about a couple of mionthis ago. No satisfactory answer has been received, and thie miatter was discussed at the Annual Representative Meeting oil July 21st, when the following resolution was adopted unianimously: That inasmuch as the provision for a 20 per cent. reduction in the retired pay of majors after twenty years' service under the R.A.M.C. Warrant can have the effect of reducing the pension of many of these officers below the sum of £1 a day which was provided by the Warrant under which they joined the Service, the Representative Body is of opinion that a serious breach of faith has beeni committed by the Government; and that therefore the Association is unable to recommend recently qualified doctors to enter the R.A.M.C., and declines to publish the terms and conditions of service in the R.A.M.C.
in the Educational Number of the BRITISH MEDICAL JOURNAL or in its other publications until the Council is assured that this and other matters under negotiation have been dealt with to its satisfaction. ROYAL AIR FORCE MEDICAL SERVICE. THE Royal Air Force Medical Service offers a career for medical men which should prove both attractive and interesting. The rates of pay and allowances are good, and a new field of scientific interest is opened up by the manifold problems which the circumstancs of aviation produce. The physical and menital fitness for, and reaction to, the varied conditions under which the flying personnel perform their functions provide much scope for research.
As promotion to the higher raniks of the service is by selection from officers who are eligible by reason of length of service, and as a certain proportion of the higher ranks will be reserved for purely scientific as opposed to administrative appointments, it will be seen that there are excellent prospects for the young medical officer who exhibits ability anid energy in scientific research, as well as for those who develop a talent for administration.
The establishment will consist partly of permanent and partly of short-service officers.
An officer will on first entry be granted a short-service coinmission for a per iod of three years on the active list (whic} may be extended to five years at the discretion of the Air Council on the recommendation of the Director of Medical Services) and of four years in the Reserve of Air Force Officers.
Selections for permaiient commissions will be made from officers holding short-service commissions, and those who are not selected will be transferred to the Reserve at the expiration of their period of service on the active list.
Short-service officers who are approved for permanent commissions, but for whom there arenot vacancies in the Royal Air Force Medical Service, may, under certain conditions, be considered for transfer to the Royal Army Medical Corps. If transferred, their service in the Royal Air Force Medical Service would count towards increments of pay and towards retired pay in the Royal Army Medical Corps.
Officers who have been selected for permanent commissions may be permitted to attend for a period not exceeding nine months a post-graduate course in general medicine and surgery, tropical and preventive medicine, and other special subjects. Such permission may be granted during the first six years of permanent service, and when attending these courses officers will receive full pay and allowances.
New entrants into the Royal Air Force Medical Service will be commissioned as Flying Officers (Medical), and will be eligible for promotion to the rank of Flight Lieutenanit (Medical) after two years' service. Officers selected for permanent commissions will normally be promoted to the rank of Squadron Leader after ten years' total service. Accelerated promotion may be carried out, in a limited-number of cases, of officers who slhow exceptional ability after the completion of eight years' service. Promotion within establishment to the rank of Wing Commander will be by selection at any period after sixteen years' total service, and to that of Group Captain by selection at any period after twenty-two years' service.
Uniform and Equipment. Medical officers will be required to provide themselves with the uniform of their rank, and with the distinguishing badges of the Royal Air Force Medical Service. They will be required to provide themselves with service dress and mess dress. The provision of full dress is entirely optional at present. An allowance towards the cost of uniform will be made when the .officer has been gazetted, as follows : (a) If he has bad no previous service as an officer in H. M. Forces or if any such previous service was terminated more than three years before the date of joining for duty, L50. (b) If he is commissioned within three years of the termination of any previous service a,i an officer in the Royal Navy, Army, Indian Army, or Royal Marines or any of the auxiliaries of those forces, but not in the Royal Air Force or its auxiliaries, L25. (c) If be is seconded from the Royal Navy, Army, Indian Arrny, or Roval Marines, L25.
Rates of Pay aitd Allowances. The rates of pay and allowances at present in force are given in Table and the standard scale'of retired pay for Group Captains and lower ranks in Table IL   TABLE II The. rates of pay (Table 1) are liable to revision. The standard rates were drawn up in 1919 in the light of the then high cost of living, and 20 per cent. of each of the standard rates is regarded as detachable and subject to alteration, eitlier upwards or dowiiwards as the cost of living rises or falls. The first revision took effect from July lst, 1924, when a reduction of approximately 51 per cent. was made in the standard rates. Subsequent revisions will be made at intervals of three years. It must, however, be clearly understood that while every consideration will be given to the reasonable and le-itimate interests of individuals, it will be competent for the Air Cc.uncil at any time to modify the regulations under which the emoliiments of the Royal Air Force are drawn, and no officer will be entitled to claim any pay, gratuity, or other advAntage conferred by a provision being at. any time added to, varied, or cancelled.
For the p.rpose of the issue of allowances a " married officer is one who is married and has attained the acre of 30 or the substantive raiik of Sqiiadron Leader, or who, irrespective of age and SEPT. -t-5.9 19251 'XHE PUBLIG -SERVICES. rank, was mairr-ied on or before September 15th, 1919, and was serving in the Royal Air Force on June 8th, 1922.
As allowances are given for specific purposes, the cost of which rnay vary at comparatively short intesvals, tile rates of allowances are liable to be reviewed as circumstances may require.
A colonial allowance is granted in certain commands abroad in aid of the expenses of living in the countries where the cost is Iligher than in the United Kingdom.
For periods of service given under Indian administration and payment, officers will come under the rates and conditions authorized from time to time by the Indian Government in so far as these rates and conditions may differ from those in this scheme. The Indian rates are at present under review.
Group Captains retire at 55-maximum retired pay £90; Wing Commanders retire at 51-maximum retired pay £600; Squadron Leaders retire at 48-maximum retired pa's £500. There will be a minimum qualifyinig period for retired pay of twenty years.
The rates of retired pay (Table II) (including the max'um rates) are standard rates which will be subject to revision as follows: 20 per cent. of each of the standard rates will be regarded as detachable and subject to alteration upwards or downwards as the cost of living rises or falls. The fist revision took effec from July 1st, 1924, when a reduction of approximately 5i per cent. was made.; subsequeet revisions will be made at intervals of three years. The revision will apply to all retired pay which is being drawn at the date of revision as well as to subsequent awards. Gra tiitics.-Short-service officers will be eligible for gratuities on passing to the reserve on the scale of £100 for each of the first two complete years of service and £150 for each of the third, fourth, and fifthi complete years. These gratuities will not be payable to officers granted permanent commissions, but the period of service under the short-service commission will count for retired pay.
Medical officers holding permanent commissions may, at the discretion of the Air Council, be allowed to retire voluntarily from the ser-vice after ten years' commissioned service with a gratuity of £1,250, or after sixteen years with a gratuity if £2,000, in lieu of retired pay.

INDIAN MEDICAL SERVICE.
As is known from the ordinary sources of information, India, but it appears abundantly clear that they will not be accepted by either.
In his speech opening the new session of the Indian Legislature at Simla on August 20th, the Viceroy said that the Government was now taking steps to give effect to the principle laid down by the Joint Select Committee of Parliament that a Minister should have the fullest opportunity of managing that field of government which sas entrusted to his care. After stating that recruitnment by the Secretary of State for the Indiaii Educational Agricultural, and Veterinary services had already ceased, lie said: " The problem presented by the Indian Medical Servie is more difficult, but here, too, the principle of establishing provincial medical services has been accepted, subject to certain conditions, which are still under conisi(leration." This statemient ieaves many essential points unexplained, and it is to be presumiied that publication of the official proposals in their entirety will not be long delayed. When issued they will be examined by the Naval amid Military Committee of the British Medical Association, arnd the decision of the Council of the Association on the advice it gives will be published in due course.
As Evidence was given oni behalf of the British Medical Association by the Medical Secretary, who pointed out that the salary offered to Class II medical officers-namely, a basic salary of £300 rising by annual increments-was, evein when the allowances and bonus were reckoned in, less than the £500 a year the Association looked upon as the minimum commencinlg salary which should be given to a whole-time medical man holding such a responsible office. The committee issued its report in November, 1923. It recommended that officers of both classes should receive an additional £50 a year, and from a communication received from the Prison Commission we understand that the pay of the whole-time prison medical staff is: Medical officer Class II, £350, rising by annual increments of £20 to £600; medical officer Class I, £650, rising by annual increments of £25 to £800. Unfurnished quarters are provided, or an allowance in lieu is made. The Civil Service bonus is paid on the salary. There are 13 medical officers Class II, 12 medical officers Class I, and 25 parttime medical officers.
The number of vacancies is never large, and promotion is slow.

_ MEDICAL PRACTICE IN BRITISH DOMINIONS
AND FOREIGN COTJNTRIES. MEDICAL Acts have now been passed in almost all places forming part of the Biritish Empire beyond the seas, and registers of duly qualified practitioiners are consequently maintained. To these registers medical men educatedin the United Kingdom are always admissible merely on pay.. ment of a registration fee, providing they produce evidence that they are of good repute and are either registered or eligible for registration in the United Kingdom, as the local requirement may be. The only exception to this statement that need be made relates to the Dominion of Canada.
Each of its provinces acts in medical matters as an independent State. The result has been that reciprocity of practice has beeni established between this couiitry and all the provinces of Canada except British Columbia, where certain obstacles still iremain to be -overcome.
We would advise any medical man proposing to practise in. Canada fiIs't to communicate withthe Provincial Registrar, stating what degrees or diplomas lie holds, and asking for information as to the precise steps he must take in order to obtain admissioni to -tlle Provincial Register.
Italy and Japan are the onily two foreign States with which complete medical reciprocity has been establislhed, though there are other countrties which graiit a limited recognition to Britislh qualifications. Geneirally speaking, irn Continental countries (with the exception of the kingdom of Italy) a British medical man desiring to exercise his profession therein must pass priactically the same examinations as those imposed on natives of the country. The same observation applies to all foreign States in the South American continent.

Each of the United States of
North America has its own laws and regulations governing rnedical practice; some of the States admit any holder of a degree or diploma to their Register, but the majority require a candidate for registration to submit to an examination.
A pamljhlet showing the conditions under which medical and dental practitioners legally qualified in their own country may practise abroad can be obtained from the office of the General Medical Council, 44, Hallam Street, Portland Place, London, W.1, price 2s. 6d., or 2s. 9d. post free in the United Kingdom. Practitioners who think of goinlg abroad to practise will find therein much useful information, including the name of the official in each country to whom requests for further lpalticulars should be addressed. The last edition was published in January, 1921. THE SUDAN MEDICAL SERVICE. THE Sudan, perhaps to a greater extent than any other British possession, is entering on a period of rapid development and expansioni, and with this expa'ision the medical services of the country must nccessarily keep pace.
The Sudan Medical Service offers maniy attr actions to a young doctor who is interested in his profession and is anixious for professionial experience, and to a man fond of an open-air life the country offers, in addition, opportunities for every kind of shooting, for fishing, and polo. (g) A number of assistant medical officers, natives of the Sudan.
A candidate, on being acoepted for the service, becomes a medical inspector. Soon after his aririival in the country he is genierally placed in charge of the medical and public health woik of a province. His headquarters is the chief towIl of the province at which there is a general hospital.
There aie usually smaller hospitals or dispensaries at less important centr'es in the province, which are under his Dhar ge, and which it is Iiis duty to super vise. He will probably have two or tlhr ee medical officers under his supervision and several assistant medical officers, as well as a sanitary staff.
Besides the ordinary provincial work, there are certain special lines of work. For instance, ther e is a hospital ship woorking alolng the various tributar ies of the White Nile among the pagan and completely uncivilized natives in those regions, a post which offers great scope for original medical work, and inicidentally provides opportunities for big-game shootinig. Theire is also the work of organizing campaigns against special diseases endemic in certain parts of the counitry, such as bilharziasis, ankylostomiasis, and yaws.
The country also affords opportunities for research into many interesting l)roblems which urgently need solution in borders of Uganda and Abyssinia, and from the Red Sea to Wadai and the French and Belgian Congos. In this enormous area are found a variety of different races and a considerable variation of climate. The Sudan may roughly be divided into three zones-a northern, a central, and a southern zone.
1. The northern desert zone is hot and dry in the summer, but with cool nights. In the winter the climate is pleasant, and often cold. This region is mainly inhabited by Arab tribes, either sedentary cultivators settled along the river or nomad tribes wandering in the desert with their flocks and herds. There are a few large towns, of which Khartoum, Atbara, and Port Sudan are the most important. Khartoum, with its adjoining towns of Omdurman and Khartoum North, has a population of about 120,000. There are large hospitals at Khartoum and Omdurman. Khartoum has a good electric lighting system and water supply. Many of the gardens have excellent grass tennis courts. Khartoum is connected to Khartoum North by a bridge over the Blue Nile, and a bridge is being constructed over the White Nile to connect it with, Omdurman. An electric tram system is being installed. Port Sudan is a rapidly growing port on the Red Sea; it has a large, well built hospital. Twenty years ago where Port Sudan now is there was only a long creek, with a few nomad Arab tents and some cattle grazing. Now, between seven and eight hundre(d large vessels enter Port Sudan in the course of the year, and 'this number is steadily increasing. Behind Port Sudan, and parallel with the sea, runs a chain of mountains inhabited by the Hadendoa tribes (the Fuzzy-wuzzies of Kipling's verses), an attractive people, still very independent and shy of all contact with civilization. In these mountains, too, the ibex and the wild sheep can be obtained.
2. The central zone for eight months in the year has much the same climate as the northern zone, but has a rainy season of four months (more or less). In this region rain crops are grown over wide areas, and the grazing is excellent. The inhabitants are for the most part Arabs, nomad and sedentary, but with a larger admixture of the black races of the south in their breeding, and in consequence a darker colouring. In this area the largest towns are Wad Medani, El Obeid, Kassala, and Gedaref. Wad Medani is the centre of the Gezirah irrigated area, an area at present comprising 300,000 acres, but which will eventually extend over an area of three million acres. At Wad Medani there is a newly constructed up-to-date hospital of two hundred beds, with eXcellent operating theatres and laboratory. Electric light is being installed. The public health work in the irrigated area is of very great interest. Malaria and dysentery have to be eliminated or kept under rigid control, and precautions have to be taken against the canals becoming infested with bilharziasis. A large sanitary staff is employed for this purpose. Wad Medani is the centre of a considerable English population employed on the irrigated area, and tennis, and, in particular, polo, are played with enthusiasm. About one hundred miles south of Wad Medani at Makwar the Blue Nile dam has been constructed to provide water for the irrigated area to the north. The dam is three kilometres in length. Its construction involved most careful sanitary and antimalarial precautions, without which the work could not have been carried out. Here, too, is a well built, up-to-date modern hospital, with accommodation for one hundred and twenty beds.
3. The southern zone becomes increasingly tropical in character as the southern boundary of the Sudan is approached. This area is inhabited by negroid peoples, for the most part quite uncivilized, and in many parts difficult to 'get in touch with, except'by means of medical work. Here the sandy scil' and the sparse acacias of the northern Sudan are replaced by forest trees and elephant grass. In the place of the gazelle, ibex, and wild sheep of the north are the elephant, the buffalo, and the sitatunga, and the other numerous tropical fauna. There is a large modern hospital at Malakal, a towin not far from the old Fashoda, where Marchand and his Cingalese troops fortified themselves after their remarkable journey across Africa, and where they were met by Lord Kitchener after his victory at Omdurman. Excellent medical work, too, is carried out by a hospital ship, which works alono the White Nile tributaries. A commencement is being made in the introduction of rain-grown cotton cultivation among the more civilized of these tribes, an industry that will in time render this southern area rich and prosperous. In the meanwhile, this region is most interesting, alike to the doctor, from the point of view of medical work and research, and to the anthropologist, the naturalist, and the hunter.
It will be seen from the above that the Sudan presenlts variety of climate, variety of work, and variety of sport; the comforts and opportunities of civilization, often almost side by side with the most primitive conditions; opportunities for medical and surgical work, and for SEPT. 5, 1925] APPOINTMENTS UNDEk IHiE COLONIAL OFFICE.
-esearch combined with an open-air life and variotus kinds )f sport. It presents the great interest of anew cotuntry apidly advancing, and in its advance presenting miedical aindplublic health problems of great difficulty, the successful solution of which is essential to the health and happiness of thie people and the prosperity of the country.
Inquiriesregarding the medical service slhould be addressed to the Ci-il Secretarv, Studan Go-ernment, Khartoum.
MIEDICAL APPOINTMENTS UNDER THE COLONIAL OFFICE. APPOINTME-NTS to the Medical Services of the Colonies and Protectorates under the administrative contlol of the Coloniial Office are made by the Secretary of State for the Colonies. Such appoinitments are to the serlvice of a given coloniy or-colonies, for there is no unified service directlv adminiistered from the Colonial Office. It follows that conditions of service and superanniuation are in the main determiiied by the economic resoui'ces and general putblic health policy of the individual colon+, an(l its local Government, anid vaiy almost as widely as do conditions of climate. Moreover, the extent of the control exercised by the Colonial Office varies according to the constitutionial status of the p)articular colony, anid the detailed information available centrally is not always complet,e. The intending candidate, therefore, should make comprehensive inquiries as to local onditions before applying for an appointmenit, and will -lo well to supplement official information by reference to tlhe central office of the British Medical Association, where reports obtained from time to time from the local Branches are available. This is the more necessary because facilities for transfer from the Medical Service of one colony or group of colonies to that of another are as yet practically nionexistent, except in connexioni with a few specialist and seiiior appointments; this sets strict limits uponi the opportunities for promotion.
The bulk of the medical appointments made by the Secretary of State in this country are to the Services in the East and West African Colonies anrd Protectorates, the Straits Settlements and Malay States, the East Indies, and Fiji and the Western Pacific. In general, candidates for such appointments must be between the ages of 23 and 35; and whilst these limits are not for the moment absolute, an officer over 35 years of age on first appointnment may be required to serve on a temporary and non-pensionable footing; regular appointments are, subject to a varying period of probation, for the most part, nonminally at least, permanent anid pensionable. There is no entrance examination, but practitioners selected for appointment must obtain a certificate of physical fitness from one of the Medical Advisers of the Colonial Office. In the case of the West rifican Medical Staff and the East African Services stuecessfsil candidates are required to undergo an approved course of instruction in tropical medicine.
Colonial Serrice: The General Outlook. WN hile colonial service offers undoubted attractions to some pr actitioners it also presents very definite disadvantages, anid niot the least of these is, at the present time, uncertaintyas to the future. Befor e the war, conditioins in several of the Services gave rise to conisiderable anxiety; the greatly enhanced cost of living during the war resulted inr cer-tain more or less inadequate temporary advances in remuneration, but consideration of the radical reforms required was postponed until the succeeding period of recois-3tr uction. In 1919 a departmental committee under the -hairmanship of Sir Walter Egerton was appoinited to conlsider the p'osition of the Services generally, the means of sec uring contentment within them, and the miaintenanice alnd inerease of ,the supply of candidates. The committee foulnd that the ideal to be ainmed at -as the creation of a uniified Colonial Service, recruited by competitirv exainiation and represented on the staff of the Colonial Office bI a Medical Director-General. As an immediately practicable Atep in this direction it riecommended the assimilationi of tle Medical Services in neighbourinig colonies, and mor e especially those in the East African and Malayan groups. I A permanient increase of salaries with a general minimum of not less than £600 a year on first appointment was recommended; the necessity for study leave was recognized, as was the need for the development of facilities for re,search; an increase in the number of specialist appointments anid adequate provision for promotion by transfer from the service of one colony or group to that of another were other points emphasized.
Progress along the lines laid down by the departmental committee, which correspond broadlv to the policy adopted by the British Medical Association, has undoubtedly beeni made since the report of the committee was issued. With the exception of the West Inidian Services, the Fiji and Pacific Colonies, and a few of the smnaller dependencies which each offer only one or two medical appointments, the adoption of the £600 minimum or its equivalent in local currency has been achieved.
The commencing pav in the West African Mledical Staff is £660 a year. Some steps have been taken towa.ds the assimilation of the East African Services, whlilst there has been an appreciable increase in the number of specialist appointments and the facilities for esearch. In general, conditions of service in West and East Africa may be taken as satisfactory, althoucgh in some instances an inCFease of staff appears desirable. Certain Services, notably those in the West Indies and Fiji, have not vet secured that measure of rieform essential to a minimal standard of efficiency. Reference may also be made to the medical services in Egypt and Iraq, hitherto largely staffed by British practitioiiers. In Egypt conditions at the present time are not such as to favour the appointment of Europeans to any Sta-te Service. In Iraq, on the other hand, the combined efforts of the Mesopotamia Branch anid the Central Office of the Associationi have recently secured essential adjustments in, conditionis of service which had previously caused considerable uncertainty and anxiety.
TIme acute economic depression of the last five years hlas affected many of the cololnies with almost crushing severity.
It has in some cases brought about the indefinite postponement of projected reform, and in others it has practicElly neutralized advances in remunieration that were at one time thought to be permanent, besides imposing disastrous restrictions on the public lhealth programme in many places, and reductions in the medical personnel of the Services. Nor do economic difficulties, radical though they are, stan-d alone. The constitutional status of the colonies is under review. Schemes for regrouping and for the concession or greater local autonomy may be temporarily delayed pending economic recovery, but it is not unreasonable to suppose that until such qtuestions are settled there can be little progress towards the unificationi of the Colonial Medical Service. Their adoption, on the other hand, may entail the formulation of a niew solution for the admitted difficulties.
Mean.while, there are some signs of an increasing departmental and parliamentary interest in the development of a sound public health policy in certain dependencies. The condition of the Colonial Medical Services has for some time been a matter of the gravest concern to the British Medical Association, which gave evidence on the subject before the Egerton Committee, and has been in constant communication with the Colonial Office on matters touchin-g their welfare since August, 1921. During this period the Association has, in effect, been recognized as the mouthpiece of the Services, andl has received copies of all official documents primarily affecting medical officers, and also the gazettes of the various local Governments. It has therefore been possible to supplement the activities of the Oversea Branches by the exercise centrally of unceasing vigilance over all tendencies likely to affect the development of the Colonial Services. Present conditions renider advance imrpracticable in certain branches of the Colonial Service, and especially is this so in the Windward Islands, w5-here three years of unremitting effort on the par t of the British Medical Association, both centrally and locally, ended in 1923 in failure. The Representative Body of the Assciation, after full consideration of the facts of the case, and with a due sense of the responsibility involved in any actiorn tending to hinder the supply of qualified candidates for the Services in these islands, passed at Portsmouth a resolution regretting that the Colonial Office had r THFBRiTts% I MEDICAL JOURNAL -452 SEPT-5, 119251 S3EPT. 5, I9053 MEDICAL R&DIOLOGY AND ELECTROLOGY.
THz BRmsis 4 53 L MEDICAL JOUBNAL declined to press the claims of the Windward-Islands medical officers with regard to their terms and conditions of service, and thoroughly endorsing the action taken by the Council in support of those claims. Such a resolution is the best possible commenitary upon, the opinion expressed in the BRITISH MEDICAL JOURNAL of June 30th, 1923, that no qualified medical practitioner aware of the conditions of service will accept an appointment in these islands. The position in this respect has not been bettered by the modification of the local Medical Ordinance to permit the employment of practitioners not qualified for admission to the M,edicalRegister of the United Kingdom.
Our information in respect to the Malayan Medical Service is incomplete, but from that in our possession w( are driven to the conclusion that, the position is not such as the British Medical Association could approve.
The services are under strength, the salaries paid are inadequate, and the administration chaotic. The Colonial Office has had the facts before it for some considerable time, and has in its possession, or ought to have in itspossession, reports of commissions of inquiry, but so far has not made public, nor has it communicated to the Association, anv decision at which it may have arrived.
East African. Medical Service.
Beyond the brief reference to this subject on the previous page, attention may be called to the opportunities offered to recently qualified medical men by the East African Medical Service. This service includes Keniya, Uganda, Tanganyika Territory, Nyasaland, Zanzibar, and British Somaliland. In East Africa-there is very wide scope for clinical work, both medical and surgical, as well as for preventive medicine and sanitation. The field of research is unbounded. The service as a whole is fully alive to its responsibilities and opportunities; individual initiative is encouraged, and the career of a medical officer depends, not on seniority alone, but to a large extent on hlis own capability. As a rule it is preferable that medical officers on first appointment should not be married, although in all but a few stations conditions allow a medical officer's wife to accompany him. Many posts entail a considerable amount of travelling, which is usually undertaken by motor car. An officer is encouraged to use his own car, and a liberal allowance is granted for running expenses. A large increase in staff of the medical service of Kenya Colony is contemplated for 1926, and there is every likelihood of a number of vacancies for suitable candidates from now onwards. The proposed increase includes both the medical and sanitary divisions of the service; the former is open to those holding ordinary medical and surgical qualifications, post-graduate experience in a hospital appointment being an advantage; posts in the sanitary division will as far as possible be filled by those holding a Diploma in Public Health. Kenya, in the climatic conditions of the greater part of the colony, approximates more to the temperate than the tropical zone. There are many opportunities for all forms of sport and recreation, and life generally is full of interest.
Reference having been made to Kenya Colony in particular, it must be mentioned that a candidate can only apply for appointment to the East African Medical Service in general; he may, however, express his preference for any particular colony, and his wishes will as far as possible be met. It should also be mentioned that the regulations allow for a transfer of a medical officer from one dependency to another, but as a rule sucll transfer only takes place on promotion or at an officer's own request.
Official Soutrces of Information. All inquiries in connexion with colonial medical appoint- x-ray and electrological department. The remaining three months can be completed at any hospital recognized by the Diploma Committee for this purpose, a list of which can be obtained, but special arrangements are made for students to continue their studies in London, where demonstrations at various hospitals are arranged, in order to give a wide experience.
In addition, an independent course is arranged bv the MEDICAL MISSIONARIES. MISSIONARY societies are in constant need of qualified men and women to fill vacancies as they occur in their hospitals, and also to enable them to take advantage of fresh openings. To those suitably endowed the mission field offers unique opportunities for interesting work, and the development of native medical schools, as training institutions in connexion with some of the larger mission hospitals, affords excellent scope for valuable work to medical men and women who are qualified to teach. It is not usually expected that medical missio-naries should take a position such as would otherwise be occupied by an ordained clergyman or minister, but it is essential that they should be prepared to exert their influence in any hospital to which they may be selnt so that a Christiani atmosphere may be maintained and the work of evangelization be carried on through the ministry of healing.
As for scientific and other qualifications for the work, medical missionaries, in addition to being physically capable of sustaininig a life which makes a great demand upon their strength, should be thoroughly well trained physicians and UNTIL the passing of the Dentists Act, 1921, the profession of dentistry in this country was regulated by enactments ver'y closely similar to those relatinlg to the practice of medicine-that is to say, tllere was no direct prohibition of the act of practice; and the Dentists Act of 1878 gave the same degree of protection to legally qualified and r-egistered dentists as was accorded to registered medical practitioners-namely, the reservation of the use of certain titles. This Act also provided (1) that no person should take or use the niame or title of " dentist " (either alone ot in combination with any other word or words) or of dental practitioner," or any othier name, title, or descriptioni expressed in words or by letters implyin'g that lie was specially. qualified topractise dentistry,. unless he u-as registered, under a penalty of £20; and (2) that an ualregistered person could not recover any fee br. charge in respect of any dental operation,. attendance, or advice. But, ini the case of the practice of medicine by unqualified anld unregistered persons, certain deterrent factors came iinto play-such as the inability to give a death certificate -and these did not operate to the same extent in the case of dentistry; hence, unqualified practice has been far moire prevalenit in dentistry thaii in medicine, and this inereased after a decision of the House of Lords placing a parrow initerpretation upon the words " specially qualified to practise dentistry," by defining the word " qualified " as niot referring to competence but to the possession of a recognized diploma. THE DaNTISTs ACT, 1921. This unsatisfactory position has now been remedied bv the passing into law of the Dentists Actt 1921; its provisions are based largely on the recommendations of a departmental committee appointed in 1917 by the Privy Council " to investigate the extent and gravity of the evils coinnected with the practice of dentistry and dental surgery by persons not qualified under the Dentists Act." Since November 30th, 1922, no person has been permitted by law to practise or hold himself out, whether directly or by implication, as practising or as being prepared to practise dentistry unless he is on the Dentists Register provided for by the Dentists Act, 1878. The practice of dentistry is iefinned as including " the performance of any such operationi and the giving of any such treatment, advice, or attenidance, as is usually performed or givenl by dentists," anid the performing of any operation or the giving of any "treantment, advice, or attendance oni or to any person as prepai:atory, to or for the purpose of or in connexion wi-ith the fitting, insertion, or fixing of artificial teetl. " The maximum penalty inecurred by an unregistered dentist is £100 for each offence. There are, hlowe-ver, certain imiiportant exception-s to the r-equirement of registrationi. A registered medical practitioner may practise dentistry withQut being on the Dentists Register, and a registered p)hiarmaaceutical chemist or chemist an2d druggist may extract a toothi where the case is urgent and wliere no doctor or dentist is available, but the operation must be performed without any kind of anaesthetic; fturtlher, any person may carry out minor dental work in a public denital service under the personal supervisioni of a registered dentist provided it is in accordance witlh coniditionis al)proved by the Minister of Health after conisultation with tlie Deln.tal Board.
-Certain i ersons other than those qualified by examination were entitled to be registered under the new Act. They lhad to be of good personal clharacter and 23 years of age before July 28th, 1921 (the commencement.of the Act), and to have been engaged for five of the seven years preceding-that date as their principal means of-livelihood in the practice of dentistry in the British Isles, or have been admitted to membership of the Incorporated Denta' Society not less than one year before the commencement of the Act. The passing of " the prescribed examination in dentistry " w-ithlin two years of the commencement of the Act is consideired as equivalent to practising for five years, and a registered phar mrceutical chemist or a chemist and druggist who immediately before.the commencement of the Act had a substantial practice as a dentist, including all dental operations, was treated as thougb he had practised for five years. A dental mechanic who for the five years had been carrying on his work as such and has secured the, entry of his name on the list of candidates for examination can be registered provided within ten years of the commencement of t-he Act he passes thie prescribed examination.
Dentistry may be carried on by a corporate body provided the majority of the directors and all the operating staff are registered dentists, and that no business other than dentistry or only somlIe business aancillary to dentistry is carried on by the compainy. Compaiiies carrying on the business of delntistry at the present tinme are permitted to continue to do so with certain restrictions, provided that-the names of the directors have been entered in a list keep by the Registrar for that purpose. Every director or manager of a company convicted of an offence under the Act will be held to be guilty of the offence unless he proves that the offence was committed without his knowledge, and the court may, in addition to a fine, order that the name of any director convicted shall be removed from the list of directors aforesaid. A subsequent Act passed in 1923 made provision for the registration of persons who were 21 in November, 1921, who had served during the late war in His Majesty's Forces, and were on that date engaged as their principal means of livelihood in the practice of dentistry in the British Isles. The Board, however, has now power to consider any further applications under this Act.
THE DENTAL BOARD. The Dental Board of the United Kingdom was established for the purpose of administering the new Act. The first members of the Board, who held office for three years, were all appointed, but their term has now come to an encd. The Board consists of: -the chairman, appointed by thlo Privy Council; three members appointed by the General Medical Counicil, who must be members of the Branch Councils for England, Scotland, and Ireland, respectively; three persons who are neither medical practitioners ilor dentists, appointed to represent England, Scotland, and Ireland; and six elected members, one -of whom. representc the qualified dentists in England and Wales, one those in Scotland, and one those in Northern Ireland, and two all the dentists registered under the Acts of 1921 and 1923.
On the establishment of the Dental Board in 1921 certain powers and duties of the General Medical Council were transferred to it, including the duty of erasing from the Dentists Regjister any entry which has been incorrectly or fraudulently made. An inquiry into the case of a person alleged to be liable to have his name erased from the Register vwill be made by the Board, which will report its" findinigs to the General Medical Council, the order directing the erasure being made, as at present, by the Council. A name erased from the Register can only be restored by the Council upon a report made by the Board. Ani appeal to the High Court may be made by aniy person aggrieved either by refusal of the Board to register lhis name or by the removal of his name from the Register.-The administrative expenses of the Board are defraved from the registration fees -and annual retention -fees, butany surplus may be allocated topurposes connected With dental education and research or to any public purpo.se conniected with dentistry. The office of the Dental Board is at 44, Hallam Street, London, -W.1.
_The Dentists Registcr for 1925 contains the' names of 13i818 persons, of whom less thani a half are registered with quialifications, 7,296 names-having been-registered tinder the Dentists Acts, 1921 and 1923. DENTAL EDUCA\TION AND EXAMINATION.
The preliminary examination in arts is the same for medical and dental students, and the early stages of their education embrace much the same subjectsi; alnd, as tlie dental studenit is required to obtain a knowledge of the broad princip)les of medlicine and surgery, it is nlecessary for hlim to pulrsule some portion of his studiies at aw medical .school as wsell as at a special dental school, the latter not S 0ee the Registrar's Memorandum, printed in the article on the General Medical c!ouncil at page 41L